Healthcare Provider Details

I. General information

NPI: 1518172295
Provider Name (Legal Business Name): CHRISTINE B KAVANAGH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 HEPBURN ST
WILLIAMSPORT PA
17701-6122
US

IV. Provider business mailing address

1616 WALNUT ST
WILLIAMSPORT PA
17701-2060
US

V. Phone/Fax

Practice location:
  • Phone: 570-567-5400
  • Fax: 877-551-9931
Mailing address:
  • Phone: 570-567-5400
  • Fax: 877-551-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP-008251
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003091
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: